Objective: To evaluate levels of occupational stress and work engagement among primary health care workers. Method: A descriptive, correlational and transversal study was carried out in a small municipality in the countryside of São Paulo, with a non-probabilistic sample of convenience, with 85 workers. Three self-applied instruments were used: one developed by researchers, containing sociodemographic variables; Work Stress Scale (WSS) and Utrech Work Engagement Scale (UWES). Results: Prevalence of women (72.6%), 40 years old or more (45.9%), 4 years and 4 months of mean working time in primary care. Thirty-one workers (36.5%) presented significant stress (scores ≥2.5). Work engagement showed a mean of 4.1 (±1.2) to 4.4 (±1.4), classified as high in all dimensions. Occupational stress and work engagement correlated negatively. Conclusion: Workers presented high levels of work engagement; more than one-third had significant occupational stress. Workers with high levels of occupational stress tend to have lower work engagement.